EGFR status was positive in the patient's lymph node specimens. The risks and benefits of first line chemoradiotherapy versus biomarker-driven therapy were discussed with the patient. Considering his poor lung function, poor performance status, and risk for treatment-related pulmonary toxicity, a shared decision was made to begin treatment with an EGFR TKI.Three months later, a repeat chest CT scan showed decrease in size of the right upper lobe mass and a small interlobar lymph node at station 11R superior, but no mediastinal or other hilar adenopathy. A total of six months after initiation of EGFR TKI therapy, another chest CT scan showed an increase in size of the right upper lobe mass and a small increase in the size of the 11R superior adenopathy. The patient is discussed again in the multidisciplinary lung cancer conference.

Each fictitious clinical case scenario is based on a conglomerate of real patient data. Cases have been modified to avoid any possibility for patient identification and to help meet educational objectives. Any resemblance to real persons, living or deceased, is purely coincidental.

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